Derenzo, Michael Pasquale

Derenzo, Michael Pasquale is an sole proprietor health care provider with primary practice located at 1 Harmon Dr , Blackwood NJ 08012-5103. He recently has only one registered license in Eye and Vision Services Providers / Optician, which is considered as his primary health care specialty. Derenzo, Michael Pasquale can be contacted via phone (856) 228-1000.

Contact Information

Primary practice address
1 Harmon Dr Blackwood NJ 08012-5103
Phone: (856) 228-1000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optician 156FX1800X 006765 New York

Profile Details

NPI number 1114678646
LBN Legal business name Derenzo, Michael Pasquale
Credentials LDO
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 17th, 2022
Last updated Jan 17th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114678646 NPPES
New York Other 006765 LICENSED OPTICIAN

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